Chapter 12 - Intervention Planning

OTPF-III: list the specific types of occupational therapy interventions that may be implemented

- therapeutic use of occupations and activities - preparatory methods and preparatory tasks - education and training - advocacy - group interventions

Common Errors in Writing Intervention Plans: intervention strategies

-Interventions to not focus on increasing functional behaviors to return the client to the least restrictive environment. - Interventions to not take the age, sex, and interest of the client into account or are not meaningful to the client. - Acquired skills are not transferred into it more functional contacts in the clients life. - Intervention strategies focus too heavily on preparatory methods without progression towards purposeful activities and occupation-based interventions.

Common Errors in Writing Intervention Plans: client involvement

-The client is not involved in the treatment planning process. And many settings, you will be required to ask the client what his or her goal is and document that goal in your evaluation or intervention plan. - Intervention plan does not reflect the client's strengths, desires, and preferences.

Sample Intervention Plan: STG3: client will complete light meal prep and clean-up using wheeled walker with SBA for safety within 3 weeks.

1. preparatory method: In collaboration with client and family, make recommendations for environmental modifications to adapt kitchen for safe except stability and mobility 2. preparatory method: Select and instructed in use of adaptive equipment for one handedness as needed to peel and chop vegetables, open cans and jars. 3. preparatory task: Remove/replace items from kitchen cabinet to improve right upper extremity strength. 4. activity: Practice item transport in kitchen using a wheeled walker and rolling cart. 5. activity: Plan a meal with attention to money management, organization, and sequencing. 6. occupation: Bake brownies in preparation for a family visit.

Other Considerations: consideration of "bottom-up" versus "top-down" activities

Bottom-up approaches use interventions that address foundational deficits related occupations such as range of motion, fine motor coordination, and attention skills. Top-down approaches involve the use of meaningful occupations and activities as means of addressing underlying claim deficits. Examples include engagement and dressing tasks, opening a toothpaste, opening a food package, and engagement in high-level cognitive processes such as self awareness of stress level strength social interaction. Top down approaches Are believed to result in better carryover and generalization of skills. OT practitioners should ensure that they are not using only bottom up approaches in their intervention plans. Effort should be made to focus on top down approaches as well.

Chapter intro

The intervention plan is a plan that will guide actions taken and that is developed in collaboration with the client. It is based on selective theories, frames of reference, and evidence. Interventions may be developed for a person, a group, or a population. For purposes of learning, This manual will focus only on interventions targeted at individuals. However the techniques described in this manual can be adapted for the occupational therapists we serve groups and populations. The intervention plan is part of the P section of an evaluation soap note. We will discuss additional requirements related to the evaluation documentation in chapter 13. In this chapter we will focus specifically on the goals, objectives, and the intervention strategies containing the intervention plan.

The OTPF-III Outlines five categories of intervention approaches that may be used in occupational therapy. name them.

health promotion, establishment of skills, maintenance of performance capabilities, modification of context, and prevention of occupational performance problems.

OTPF-III: five categories of intervention approaches - establishment of skills

Establishment of skills not yet developed or remediation/restoration of impaired skills.

OTPF-III: five categories of intervention approaches - maintenance of performance capabilities

Maintenance of performance Capabilities, assuming that performance would decrease without intervention. Note that the word maintain as a red flag word for reviewer's: when documenting this approach it is essential to elaborate on how the lack of occupational therapy services with lead to a significant decrease in occupational performance for the client. This is especially true for a progressive disorders such as Parkinson's disease.

OTPF-III: five categories of intervention approaches - modification of context

Modification of contacts or activity through compensatory techniques or adaptation

The Intervention Planning Process: preparatory methods and preparatory tasks

These methods and tasks help prepare the client for performance of occupations. These intervention approaches may be used as a part of a treatment session in preparation for or concurrently with occupations and activities were provided to client as a home based engagement to support daily occupational performance. Includes stretching exercises and warming up exercises.

The Intervention Planning Process: Therapeutic use of occupations and activities

These type of interventions involves selecting specific occupations and activities as interventions to meet the client's goals.

Other Considerations: theoretical basis of intervention

Throughout your O2 curriculum, it will be introduced to several theories, conceptual models, and frames of reference but guide occupational therapy practice. As you are developing an intervention plan, you should be able to relate your plans interventions back to one or more frames of reference (A system of compatible concepts from theory that guide a plan of action for assessment and intervention with specific OT domains).

Common Errors in Writing Intervention Plans: goals

- Goals are not functional or do not focus on the reason for referral to occupational therapy. - Intervention plan does not focus on specific rehabilitation goals that will increase clients ability to engage in meaningful occupation in the probable discharge environment. - Goals focus on the client participating in or cooperating with treatment (Unless the client is in the habit of refusing treatment; more acceptable in mental health and behavioral health settings). - Goals are not measurable or do you not have a target date for completion.

Common Errors in Writing Intervention Plans: Problem identification

- Problems identified in the assessment are not addressed in the plan. - Problems are not stated in terms of behavioral manifestations, area of occupation, and contributing factors. - The number of visits requested does not match the severity of the documented problems.

Sample Intervention Plan: STG 2: Client will dress self with min assistance within 2 weeks using right upper extremity as a functional assist

1. preparatory task: UE exerciser a.k.a. arm bike for increased right upper extremity strengthening 2. Preparatory method: Instruct in adaptive dressing techniques and adaptive equipment as needed: long shoehorn, elastic laces, reacher, buttonhook. 3. preparatory task: Facilitate trunk control and balance and weight shift forward and backward, side to side, and in rotational patterns while engaged in reaching for objects. 4. activity: Practice use of buttonhook to fasten buttons on shirt. 5. occupation: Complete morning dressing routine using right upper extremity to hold bra while hooking in front, assistant pulling up pants, and stabilize shirt while buttoning.

Other Considerations: determining frequency and duration of treatment -clinical pathways

A clinical pathway a.k.a. critical care pathway, is a standardize interdisciplinary management plan involving a particular sequence Of clinical interventions, timeframe, milestones, and expected outcomes for a homogenous patient group. The purpose of clinical pathways is to provide care in a cost-effective manner, essentially reducing the length of inpatient hospitalization. it includes a standard intervention plan based on the predictable course of recovery. Keep in mind that the clinical pathway lists interventions that the therapist will use. The clients goals still need to be written and occupation-based terms.

Common Errors in Writing Intervention Plans: "Canned" Plans

Cans intervention plans reflect the same goals, objectives, and intervention for each client based on the diagnosis and services available rather than on the clients need (even clinical pathways need to be individualized to fit the client.)

Sample Intervention Plan

Client name: Norma H Age: 83 1st diagnosis of left cerebrovascular accident. 2nd diagnosis of Diabetes mellitus. Frequency/Duration: 30 minutes 2x/day for 3 weeks. occupational profile: Mrs. H is a widow who lives with her daughter and grandson in a one-story house in a small town. Mrs. H was independent in all ADL and IADL tasks before her CVA. She has never worked outside her home. She raised 7 children in the town where she now resides and takes pride in her ability to do homemaking tasks such as cooking, sewing, and decorating. She drives in her own small town, but is not comfortable driving long distances. She intends to return to the home she shares with her daughter and grandson and hopes to return to her PLOF. Problem: Client requires mod assistance in self-care due to inability to spontaneously use right uper extremity secondary to left CVA. Long term goal: client will complete all ADL and IADL activities with modified independence within 3 weeks.

The Intervention Planning Process: group interventions

Decimal sees of OT practitioners leader ship to facilitate learning and skill acquisition to the dynamics of group and social interaction. Examples include a social skills group for adolescence on the autism spectrum, a cooking skills group for adults with developmental disabilities, etc.

Other Considerations: determining frequency and duration of treatment

It may seem impossible to new therapist to estimate how much time will be needed to accomplish goals, but you will find that you really can't do it. Please remember that the intervention plan is made to be changed. If your original estimate does not turn out to be accurate, you change it as you find out how quickly your client progresses.

The Intervention Planning Process

From the moment a referral is received, intervention planning begins in the mind of a therapist. A name, age, and reason for referral should stimulate occupational therapists to begin reviewing and his or her mind the areas of occupation likely to be assessed, the areas of deficit that might be found, and the possible interventions that will benefit the client. From day one, a good therapist also begins discharge planning based on the clients occupational profile, prior level of performance, and probable discharge placement. The guidelines for documentation of occupational therapy identify the components that should be included in an intervention plan: -client name and demographic information -measurable occupation based goals and objectives -intervention approaches and types of interventions to be used -service delivery mechanisms including provider, location, and frequency/duration -plan for discharge including discharge setting, follow up care, and discontinuation criteria -outcome measures such as standardized and non-standardized assessments -Professionals responsible for plan and date of plan development, review, or modification.

OTPF-III: five categories of intervention approaches - health promotion

Health permission to create activities, enrich contexts, and enhance performance.

Other Considerations

In addition to being aware of the different intervention approaches and techniques, there are other factors that must be considered when setting goals in selecting interventions to meet those goals.

The Intervention Planning Process: education and training

In addition to the hands-on intervention approaches, occupational therapy practitioner is often engage in education and training with their clients. Education is defined as importing of knowledge and information about occupation, health, well-being, and participation that enables the client to acquire helpful behaviors, habits, and routines that may or may not require application at the time of the intervention session. Training is the facilitation of the acquisition of concrete skills for meeting specific goals in a real life applied situation. Skills were first to measurable components of function that enable mastery.

Sample Intervention Plan: STG 1: Client will complete grooming tasks with set-up using right UE spontaneously as a functional assist within 1 week.

Intervention: 1. preparatory task: normalize tone through weight-bearing on right UE while engaged in activities that require weight shifts like sorting laundry, or playing a boardgame. 2. preparatory task: Therapy putty exercises to improve hand and finger strength. 3. preparatory method: Neuromuscular electrical stimulation to strengthen right wrist extensors. 4. preparatory method: Handling, joint approximation, and muscle stretch in preparation for facilitation of grasp/release for prehension. 5. activity: Provide activities that require use of right upper extremities as an assist (stabilizing tablet or clipboard while writing). 6. occupation: Complete morning grooming routine involving stabilizing toothpaste from removing wood and applying body lotion.

OTPF-III: five categories of intervention approaches - prevention of occupational performance problems

Prevention of occupational performance problems for clients with or without a disability

Other Considerations: estimating rehab potential

Rehab potential should always be stated as good or excellent for goals you and the client have selected. If your client's rehab potential is not good or excellent for these stated goals, you may need to select smaller, or incremental goals. Estimating rehab potential as poor, fair, or guarded as a red flag to revers and they may be reluctant to set aside healthcare dollars for someone who is unlikely to benefit from your intervention.

Other Considerations: selecting meaningful intervention strategies

The difference between competent and exceptional occupational therapy may lie and the ability to find meaningful activities, and design days into intervention strategies. The occupational therapist ask questions such as the following: what do you want to be able to do? What keeps you from being able to do that? What are the possible options for making that happen? The options for intervention strategies may include teaching new skills or patterns, working to increase client factors like range of motion, strength, and endurance, or modifying the environment to improve occupational performance.

The Intervention Planning Process: advocacy

This involves effort strikes at sports promoting occupational justice and empowering clients to seek and obtain resources to fully participate in daily life occupations. Advocacy efforts may be undertaken by the occupational therapy practitioner or by the client. Examples include collaborating with a client to procurement reasonable work accommodations in serving on a community board to encourage universal design of parks and recreational facilities. Examples of self advocacy include a college student with learning disabilities making an appointment with the office of disability services to prepare reasonable educational accommodations.